DIAGNOSING PROSTATE PROBLEMS: PSAS AND WATCHFUL WAITING

The main flaw of the PSA test has been that a high reading may only indicate enlargement of the prostate due to infection or irritation and not cancer, thus leading to unnecessary surgery. A study by a team at Johns Hopkins University resulted in a process for fine-tuning the PSA test to solve this problem. In this study, each man's PSA density was calculated, then the men's prostates were biopsied to allow microscopic evaluation of tissue. Six cores of tissue from various sections of the prostate were removed. The Hopkins researchers estimated that tumors would be nonaggressive in 11 percent of the men with PSA levels over 4 ng/ml. Subsequent surgical examination of all of the men's prostates proved that this prediction was correct.

As a result, new guidelines were established for watchful waiting, also called deferred maintenance or active surveillance. In this process, the doctor monitors die patient on a regular schedule, as long as patients fulfill the following criteria:

Their PSA density must be less than 0.15 (a PSA value that is 15 percent of the total weight of the prostate gland, as estimated by ultrasound).

No more than two cores of prostate tissue removed at biopsy should show any evidence of cancer.

Less than 50 percent of any single biopsy core should contain cancer cells.

Any cancer cells must be "less aggressive," meaning that they are likely to be slow growing.

Additionally, a patient's age is taken into account. Because prostate cancer is slow growing, older men with small minors can more safely opt for watchful waiting than can younger men. Men in their fifties and early sixties who have prostate cancer are likely to live long enough for their disease to develop, while men in their late seventies and eighties are likely to die from something else before their prostate minors can become life-threatening. "Men in their upper sixties with insignificant minors are particularly good candidates for watchful waiting," according to Dr. Patrick C. Walsh of the Johns Hopkins Medical Institution in Baltimore.

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Men's Health Erectile Dysfunction